When Hours Matter: A 24/7 Laboratory and Fast-Track Diagnostic Pathway for Blood Cultures in Critical Patients.

Background/

Objectives

Bloodstream infections are among the most severe infectious diseases, with mortality rates up to 25%. Delays as short as one hour in the diagnosis or initiation of the appropriate antimicrobial therapy can significantly worsen patient outcomes.

Methods

This retrospective study, in an Italian 900-bed hospital from January 2019 to December 2024, evaluates the impact of a 24/7 reorganization of the clinical microbiology laboratory, adding a night shift to ensure around-the-clock processing and introducing a fast-track diagnostic pathway to prioritize the blood cultures from critically ill patients (called urgent blood cultures) in terms of turnaround times for Gram staining, microorganism identification, and resistance marker detection.

Results

A total of 194,171 blood cultures were processed. Following the implementation of the 24/7 model, the median Gram stain turnaround time decreased from 4.46 to 1.40 h, microorganism identification turnaround time decreased from 5.75 to 2.35 h, and resistance marker turnaround time from 6.97 to 2.68 h. Significant reductions were observed especially during night shifts. Urgent blood cultures yielded a higher positivity rate (16.22% vs. 13.04%) and included the isolation of time-critical bacteria that can cause meningitis, such as Streptococcus pneumoniae.

Conclusions

The continuous around-the-clock processing of blood culture and prioritized blood cultures for critically ill patients significantly reduced reporting times, particularly overnight. This model enhances early sepsis management and exemplifies how tailored and precision microbiology, supported by strong interdisciplinary collaboration and effective communication, can enhance earlier targeted antimicrobial treatment.